The Psychological Condition of Depression:

This paper concentrates on the condition of depression which is a deep level of emotional turmoil and can affect many people in different ways. Depression affects individual’s families, the work place and anyone that is in regular contact with the depressed person. The cause can be a variety of factor including stress, fear, loneliness, guilt even anger. Many Biblical people suffered from depression including King David, Elijah, and Job. This paper will cover the DSM-IV classification for depression, the historical approaches, various treatments, and prevention of depression.

The psychological condition of depression

The psychological condition of depression affects the whole person in body, soul and the spirit. It leaves a person of a sense of hopelessness. According to the DSM-IV, a person who suffers from major depressive disorder must either have a depressed mood or a loss of interest or pleasure in daily activities consistently for at least a two week period. This mood must represent a change from the person’s normal mood; social, occupational, educational or other important functioning must also be impaired by the change in mood. According to the DSM-IV five or more of the following symptoms, one of which should be depressed mood description of depression

Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). (In children and adolescents, this may be characterized as an irritable mood.)

Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.

Significant weight loss when not dieting or weight gain (e.g., a change of more than 5 of body weight in a month), or decrease or increase in appetite nearly every day.

Insomnia or hypersomnia nearly every day

Psychomotor agitation or retardation nearly every day

Fatigue or loss of energy nearly every day

Feelings of worthlessness or excessive or inappropriate guilt nearly every day

Diminished ability to think or concentrate, or indecisiveness, nearly every day

Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide. (American Psychiatric Association. 2000, p.350).

Psychotic symptoms such as delusions or hallucinations are not common in depression but do occur in about 15% of patients with major depression. “According to one recent study the average major depression lasts four months. More than half of the people with one depressive episode will have a second, and 80% of people with two episodes will have a third.” (Lyle, 210).

The disorder in its historical context

Depression first entered the diagnostic manual around the 1960’s, just over 50 years ago. Psychoanalysis was often the treatment, yet many suffered in silence. Today, millions of Americans are treated, often with antidepressants. Cognitive therapy and Aaron T. Beck focused on the negative thinking that caused depression. It was his writings about the cognitive triad and the pattern that triggers depression. The depressed person holds a negative view of themselves and they blame their inadequacies and their inability to bring happiness on these negative views. The second part of the triad is the tendency to interpret experiences in a negative manner. The third leg of the triad was is a gloomy vision and projections about the future. Beck’s therapeutic approach was to treat depression by focusing on specific problem areas and the reasons the clients give for their symptoms. (Cory, 2009).

Psychodynamic therapy is based on the assumption that a person experiences depression as a result of unresolved, generally unconscious conflicts, often stemming from childhood. The goal of this type of therapy is for the patient to understand and cope better with these feelings by re-experiencing them through talking about them. Psychodynamic therapy is administered over a period of three to four months, although it can last longer, even years. (Comer, 2011).

Current research as to the cause of the illness

Depressive disorders affect approximately 18.8 million American adults a year. There has been an increase of depression at a rate of 23%. There is an estimated 80% who are not currently undergoing any form of treatment. This could be because of the lack of information, the shame that is associated with the diagnoses of depression or the denial that there is depression (Lyle, 2010).

Although there is no consensus as to the causes of depression there are many socio-economic and cultural changes that can affect mental health. Depression is a common mental health disorder that is evident in depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy and poor concentration. Even in its mildest form, depression interferes with the quality of life and performance of individuals. The severe forms can lead to incapacitation and even suicide. Depression is both treatable and preventable. This needs to be understood to help and support clients with depression. People’s perceptions of their illness often determine when and how they access and utilize services. (Fu, 2009).

Women are twice as likely to become depressed as men. Usually this is due to hormones and body chemistry that triggers the depression. Depression can consistently be elevated throughout the life cycle for women. According to Dr. Michael Lyles there are risk factors for women who could suffer from depression. They include a lack of confidence, less than a high school education, young children at home, unstable marital history, lack of work outside the home, personal feelings of helplessness and co morbid anxiety. There is also the problem with estrogen and serotonin. Estrogen acts as a serotonin multiplier. Many women experience certain behavioral and physical changes associated with phases of their menstrual cycles. In some women, these changes are severe, occur regularly, and include depressed feelings, irritability, and other emotional and physical changes. Called premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD), the changes typically begin after ovulation and become gradually worse until menstruation starts. Scientists are exploring how the cyclical rise and fall of estrogen and other hormones may affect the brain chemistry that is associated with depressive illness. Postpartum mood changes can range from transient “blues” immediately following childbirth to an episode of major depression to severe, incapacitating, psychotic depression. Studies suggest that women who experience major depression after childbirth very often have had prior depressive episodes even though they may not have been diagnosed and treated. Pregnancy (if it is desired) seldom contributes to depression, and having an abortion does not appear to lead to a higher incidence of depression. Women with infertility problems may be subject to extreme anxiety or sadness, though it is unclear if this contributes to a higher rate of depressive illness. In addition, motherhood may be a time of heightened risk for depression because of the stress and demands it imposes. Menopause, in general, is not associated with an increased risk of depression. In fact, while once considered a unique disorder, research has shown that depressive illness at menopause is no different than at other ages. The women more vulnerable to change-of-life depression are those with a history of past depressive episodes. (Lyles, 2010).

Various treatment approaches for this disorder, including the benefits of the treatment

There are many people who suffer from a treatment resistant depression. There are strategies for treating partial response or nonresponsive to antidepressant therapy which would include optimization, drug substitution, combination therapy and augmentation therapy. Researchers have concluded that substitution, combination, and augmentation therapies show some promising results regarding symptom reduction and remission to the disorder. (Minirth, 2010).

Some of the newer and innovative therapies for treating resistant depression could include genomic medicine which is taking the P45 genotyping test to look at the specific genes and how they respond to certain antidepressants. The Vagus Nerve Stimulation (VNS), which was approved by the FDA in 2005 is the surgically implanted pulse generator to affect the limbic system. Transcranial Magnetic Stimulation (TMS) this is an experimental procedure that uses magnetic fields to alter the brain activity. (Minirth, 2010).

Electroconvulsive therapy (ECT): A treatment for depression in which electrodes attached to a patient’s head send an electrical current through the brain, causing a convulsion. (Comer, 2011, p. 200). This therapy is controversial because two electrodes are attached to the patient’s head and a volt of electricity passes through the brain for a half second. This causes the brain to seize. It requires 6 to 12 treatment over a 2 to 4 week treatment for the patients to feel less depressed. The patients who receive the ECT have difficult remembering the event, which will clear up within a few months. “Studies find that between 60% and 80% of ECT patients improve.” (Comer, 2011, p. 201). This procedure is particularly effective in severe cases of depression that include delusion. (Comer, 2011).

Research as to the prevention of the illness

There are some techniques that can help defeat depression by allowing the light of the love of God to permeate into the darkness of depression. Ecclesiastes 3 tells us to everything there is a season, and a time to every purpose under the heavens verse 4 continues by saying, “A time to weep, and a time to laugh; a time to mourn, and a time to dance” (Holy Bible, 1988). You have to confront any losses in your life, allowing yourself to grieve and to be healed. You have to quit negative thinking and negative self talking. Philippians 4:8-9 supports the refraining from negative thinking by saying to focus on the things that are honest and true, whatever are just, pure, lovely and things that are of good report. If there is any virtue and if there is any praise, these are the things you should be thinking on. Verse 9 brings the point home “Those things, which ye have both learned, and received, and heard, and seen in me, do: and the God of peace shall be with you.” (Holy Bible, 1988). Exchange your hurt and anger for thanksgiving, and give thanks even when you don’t feel thankful. (Hunt, 2008).

Cross-cultural issues pertaining to the topic

Depression is a worldwide phenomenon. A study of four countries-Canada, Switzerland, Iran, and Japan- found that the great majority of depressed people in those very different countries reported the same symptoms of sadness, joylessness, anxiety, tension , lack of energy, loss of interest, loss of ability to concentrate, ideas of insufficiency, and thought of suicide. (Comer, 2011). Depressed people in non-Western countries-China and Nigeria- are more likely to be troubled by physical symptoms such as fatigue, weakness, sleep disturbances, and weight loss. Depression in those countries is less often marked by cognitive symptoms such as self-blame, low self-esteem, and guilt. “A study of one Native American community in the US showed that their lifetime risk of developing depression was 37% among women, 19% among me, and 28% overall, much higher than the risk in the general US population.” (Comer, 2011, p. 217).

Depression in low income women is a significant problem for both the mothers and their children. The economic stress increases risk for depression. The social stigma of poverty may encourage not seeking treatment. (Gjesfield, 2010). It is believed that 80% of women with depression are low in vitamin B and folic acid. (Weber, 2010).

Studies show that women molested as children are more likely to have clinical depression at some time in their lives than those with no such history. Abuse victims may have low self-esteem, a sense of helplessness, self-blame, and social isolation. People who were abused and neglected during childhood have a higher risk of major depression when they become young adults, according to a report in the January issue of the Archives of General Psychiatry, one of the JAMA/Archives journals. (JAMA, 2007).

Discuss the topic from a Christian worldview perspective

The Bible is full of examples of strong faithful people who faced depression they faced the feelings of isolation and rejection, great sadness, problems eating and sleeping. There is a lack of faith and loneliness in every example that is given. The way every one of the faithful people reconciled their depression was fervent prayers to God. There must be a real and personal relationship with God and accept the help when it is offered by Him.

King David, experienced symptoms of depression during particularly stressful periods in his life. Psalms 102:1-9. He writes of losing meaning and purpose in his life, losing his appetite, he has feelings of isolation and rejection. King David complains of having problems sleep, and having frequent crying spells. David reached out to the LORD and praised Him for being his strength and song, which had become his salvation in Psalm 118:14.

Elijah also demonstrated signs of depression in Kings 19. His life was threatened and he became afraid. Elijah focused on his situation and not on God. Elijah fell into a depression where his fear became so intense that he eventually ran away and isolated himself even praying for death. He stopped eating and collapsed into sleep. The LORD gave food for Elijah, providing an angel to remind him that he was not alone. Elijah was given encouragement and strength by eating, drinking and resting.

Job is an example of not only physical and emotional pain but spiritual pain as well. Job 30:15-17 finds Job crying out that his soul was poured out upon him; the days of affliction have taken hold of him. Job never gave up on God and never turned away from Him.

Some of the greatest men and women in history and in the Bible have battled depression. Clinical depression can debilitate strength and hope. It can come upon an individual gradually or suddenly and, if not properly recognized and dealt with in a timely fashion, can render one helpless. God’s plan is not for his people to spend the rest of their lives in bondage to depression. Instead, He has made it possible to defeat and gain victory over the battle of depression. Depression is treatable through various ways God has made available. Faulty ways of thinking can be defeated. There is a need to practice daily to develop the mind of Christ and not allow the faulty way of thinking.

John 14:27 gives us encouragement in these words; “Peace I leave with you, my peace I give unto you: not as the world giveth, give I unto you. Let not your heart be troubled, neither let it be afraid.” Ed Hindson said “Life is a pilgrimage, it is a process of growth and there are no shortcuts to maturity. You can only get there by walking the rough road of life. Each step is a divinely appointed opportunity to bring us closer to the pinnacles of spiritual growth and maturity.” (Hindson, 2003 p. 205).

In closing, depression can be caused by times of loss from the loss of a loved one, a loss of a job or lifestyle and even the loss of self-esteem. There are also the stress issuers in today’s society with every moment being filled with activities of things to do. Research has indicated that some depression can be a result of a chemical imbalance in the brain. The main cause of depression is faulty thinking. Those distorted thinking patterns that control how people responds to stressors.

CONCLUSION

It would be worthwhile for future research to explore and focus on identifying types of faulty thinking and help individuals to get a handle on depression before it become debilitative. How can this society help people recognize that there they are not alone in any situation. There needs to be a method that helps people at risk to recognize the difference between their feelings and emotions and truth. Just because someone feels worthless does not mean they are worthless. Steps must be taken to educate and guide people at risk for depression to recognize and act on the treatment and recovery method before it becomes debilitative. 2 Corinthians 4:8-18 is a great passage to remind us that when in hard situations, despair, persecution and abandonment we can still avoid depression. We can still be renewed every day by keeping our eyes and hearts on Jesus Christ.

Joanne Holstein is a Becker Bible Studies Teacher and Author of Guided Bible Studies for Hungry Christians. She is a graduate of Psychology/Christian and Bible Counseling with Liberty University. She is well-known as a counselor to Christian faithful who are struggling with tremendous burden in these difficult times. She is a leading authority on historical development of Christian churches and the practices and beliefs of world religions and cults.